BACKGROUND

Malignant tumors of the skull base are rare. Therefore, no single center treats enough patients to accumulate significant numbers for meaningful analysis of outcomes after craniofacial surgery (CFS). The current report was based on a large cohort that was analyzed retrospectively by an International Collaborative Study Group.



METHODS

One thousand three hundred seven patients who underwent CFS in 17 institutions were analyzable for outcome. The median age was 54 years (range, 1–98 years). Definitive treatment prior to CFS had been administered in 59% of patients and included radiotherapy in 367 patients (28%), chemotherapy in 151 patients (12%), and surgery in 523 patients (40%). The majority of tumors (87%) involved the anterior cranial fossa. Squamous cell carcinoma (29%) and adenocarcinoma (16%) were the most common histologic types. The margins of surgical resection were reported close/positive in 412 patients (32%). Adjuvant postoperative radiotherapy was received by 510 patients (39%), and chemotherapy was received by 57 patients (4%).



RESULTS

Postoperative complications were reported in 433 patients (33%), with local wound complications the most common (18%). The postoperative mortality rate was 4%. With a median follow-up of 25 months, the 5-year overall, disease-specific, and recurrence-free survival rates were 54%, 60%, and 53%, respectively. The histology of the primary tumor, its intracranial extent, and the status of surgical margins were independent predictors of overall, disease-specific, and recurrence-free survival on multivariate analysis.



CONCLUSIONS

CFS is a safe and effective treatment option for patients with malignant tumors of the skull base. The histology of the primary tumor, its intracranial extent, and the status of surgical margins are independent determinants of outcome. Cancer 2003;98:1179–87. © 2003 American Cancer Society.



DOI 10.1002/cncr.11630

Craniofacial surgery for malignant skull base tumors: report of an international collaborative study

Polyhydroxyalkanoates (PHAs) have been established as biodegradable polymers since the second half of the twentieth century. Altering monomer composition of PHAs allows the development of polymers with favorable mechanical properties, biocompatibility and desirable degradation rates, under specific physiological conditions. Hence, the medical applications of PHAs have been explored extensively in recent years. PHAs have been used to develop devices, including sutures, nerve repair devices, repair patches, slings, cardiovascular patches, orthopedic pins, adhesion barriers, stents, guided tissue repair/regeneration devices, articular cartilage repair devices, nerve guides, tendon repair devices, bone-marrow scaffolds, tissue engineered cardiovascular devices and wound dressings. So far, various tests on animal models have shown polymers, from the PHA family, to be compatible with a range of tissues. Often, pyrogenic contaminants copurified with PHAs limit their pharmacological application rather than the monomeric composition of the PHAs and thus the purity of the PHA material is critical. This review summarizes the animal testing, tissue response, in vivo molecular stability and challenges of using PHAs for medical applications. In future, PHAs may become the materials of choice for various medical applications.

Biomedical applications of polyhydroxyalkanoates, an overview of animal testing and in vivo responses

Objective:To evaluate contemporary trends in etiology, diagnosis, management, and outcome of descending necrotizing mediastinitis (DNM) and to draw the clinician's attention on this probably underappreciated disease.Summary of Background Data:An uncommon but one of the most serious forms of mediasti

Descending necrotizing mediastinitis: contemporary trends in etiology, diagnosis, management, and outcome.

Management of descending necrotizing mediastinitis.

The purpose of this paper is to organize and summarize existing information on delayed medical attention for women with breast cancer and identify research needs in this area. This review is organized in six parts: origins and permanence of the message 'do not delay' medical attention for potential cancer symptoms; definition and classification of breast cancer delay; impact of delay on breast cancer prognosis; factors related to breast cancer delay and the ways these have been studied; the study of breast cancer delay in Mexico; and directions for future research in developing countries, with a special focus on Mexico. We point out the need of a more integral study of delay that takes into account socio-structural and health services factors, in order to find modifiable factors towards which political actions should be directed to improve breast cancer medical attention in underdeveloped countries.

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Delay of medical care for symptomatic breast cancer: a literature review

Background: Descending necrotizing mediastinitis resulting from oropharyngeal abscess, is a serious, life-threatening infection. Exisiting strategies for surgical management, such as transcervical mediastinal drainage or aggressive thoracotomic drainage, remain controversial.Methods: Four patients, (three males and one female) were treated for descending necrotizing mediastinitis resulting from oropharyngeal infection. Two had peritonsillar abscesses, while the others experienced dental abscess and submaxillaritis. Descending necrotizing mediastinitis received its classification according to the degree of diffusion of infection diagnosed by computed tomography. Mediastinitis in two cases, (Localized descending necrotizing mediastinitis-Type I), was localized to the upper mediastinal space above the carina. In the others, infection extended to the lower anterior mediastinum (Diffuse descending necrotizing mediastinitis-Type IIA), and to both anterior and posterior lower mediastinum (Diffuse descending necrotizing mediastinitis-Type IIB). The spread of infection to the pleural cavity occurred in three cases.Results: The surgical outcome concerning each of the patients was successful. Radical cervicotomy (unilateral in three patients, bilateral in the other) in conjunction with mechanical ventilation with continuous postoperative positive airway pressure, was performed in all cases. Tracheostomy was established in three patients and pharyngostomy in two. The two descending necrotizing mediastinitis-Type I cases were successfully managed with transcervical mediastinal drainage. The descending necrotizing mediastinitis-Type IIA case received treatment through transcervicotomy and anterior mediastinal drainage through a subxiphoidal incision. The patient with descending necrotizing mediastinitis-Type IIB required posterior mediastinal drainage through a right standard thoracotomy followed by left minimal thoracotomy.Conclusions: The mediastinal infection, the extent of which has been accurately determined by computed tomograms, necessitates radical cervicotomy followed by pleuromediastinal drainage. Situations where infection has spread to posterior mediastinum, particularly when it reaches in the level of the carina (descending necrotizing mediastinitis-type I), may not always require aggressive mediastinal drainage. In comparison, diffuse descending necrotizing mediastinitis-Type IIB demands complete mediastinal drainage with debridement via thoracotomy. Subxiphoidal mediastinal drainage without sternotomy may provide adequate drainage in diffuse descending necrotizing mediastinitis-Type IIA.

Guideline of surgical management based on diffusion of descending necrotizing mediastinitis

Surgical results of skull base surgery for the treatment of head and neck malignancies involving skull base: multi-institutional studies on 143 cases in Japan.

Combined therapy with conservative surgery, radiotherapy, and regional chemotherapy for maxillary sinus carcinoma: Treatment of Maxillary Sinus Carcinoma

We performed simultaneous infrared/video and electronystagmorgraphy (ENG) recordings of eye movements in 417 patients with disequilibrium. Of that number, 54 patients with the following two criteria participated in this study: verified diagnosis of peripheral vestibular disease and the presence of positional nystagmus recorded by ENG and an infrared/ video recording system. Although horizontal nystagmus was the most common, torsional, vertical and oblique nystagmus were also demonstrated in these patients. The most striking finding was the high incidence of oblique nystagmus closely related to a significant right-left difference of the caloric response in benign positional vertigo.

Mamoru Miyata

Papers

Guideline of surgical management based on diffusion of descending necrotizing mediastinitis

Surgical results of skull base surgery for the treatment of head and neck malignancies involving skull base: multi-institutional studies on 143 cases in Japan.

Combined therapy with conservative surgery, radiotherapy, and regional chemotherapy for maxillary sinus carcinoma: Treatment of Maxillary Sinus Carcinoma

Infrared/video ENG recording of positional nystagmus in subjects with peripheral vestibular disease.

Spontaneous nystagmus in normal subjects